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Kenneth H. Cooper MD, MPH

 
 
 

Is gluten really as ‘bad’ as the public perceives it to be?

Posted in
Eat better

Thursday, Sep 03, 2015

It never ceases to amaze me how basic facts regarding nutrition can get blown out of proportion by the general population as well as the media. Take gluten, for example. If you listen to what most people are saying, you’d think that gluten is Public Enemy #1! Countless people are going to great lengths to avoid gluten in their diets, and food manufacturers are touting their ‘gluten-free’ products as being healthy. According to a survey by U.S. News and World Report, 41% of U.S. adults believe that ‘gluten-free foods are beneficial for everyone. However, before we all jump on the ‘anti-gluten’ bandwagon, let’s look at some basic facts.

Gluten and Celiac Disease. Gluten is a protein that is found in grains such as wheat, barley, and rye. Approximately 1% of the U.S. population suffers from celiac disease, which is a type of autoimmune disease. Individuals with celiac disease are extremely sensitive to gluten-containing grains; consuming these grains causes symptoms including bloating, gas, and diarrhea. In people with celiac disease, gluten causes the production of antibodies which cause inflammation and damage to the lining of the small intestine. This makes it more difficult to absorb nutrients through the intestinal wall and into the bloodstream. Thus, avoiding the previously-mentioned types of grains is part of the standard of ordinary care for patients with celiac disease. However, it is important to note that celiac disease can only be accurately diagnosed via blood tests and a small intestine biopsy. Because many other conditions can cause the previously-mentioned symptoms of celiac disease, individuals are strongly urged not to attempt a self-diagnosis. A board-certified gastroenterologist is the type of physician who is best-qualified to diagnose this and other related conditions.

Gluten Sensitivity. Gluten sensitivity is not the same thing as celiac disease. While gluten sensitivity can trigger the same unpleasant symptoms as celiac disease, there is no antibody production and no damage to the lining of the small intestine among gluten-sensitive individuals. It is estimated that as much as 6.5% of the U.S. population is gluten-sensitive. While it is important that these individuals avoid gluten-containing grains, individuals in this group should also be diagnosed by a qualified medical professional. A recent study1 strongly reinforces this concept. A group of 392 patients in Italy were recently followed over a 2-year period. At baseline, all patients believed that they either had celiac disease or were gluten-sensitive. After a 6 month period of a gluten-free diet, and a 1 month period where gluten was reintroduced into the diet, 6.6% of the patients were found to have celiac disease, 7% were found to have gluten-sensitivity, and 0.5% was found to have wheat allergy. The remaining ~86% did not experience any change of symptoms with a gluten-free diet. Thus, a self-diagnosis is most often an incorrect diagnosis!

So, What about the Other 92% of the U.S. Population? While there is no doubt that individuals with celiac disease, gluten sensitivity, or wheat allergies should avoid gluten-containing foods, these individuals make up only ~8% of the U.S. population. There is no evidence that gluten is harmful in any way, shape, or form for the remaining 92% of the population. In fact, increased consumption of whole grains is one of many effective strategies for decreasing the risk of future type 2 diabetes, cardiovascular disease, metabolic syndrome, and colorectal cancer.

Not all Gluten-Free Foods are Healthy. I had to laugh the other day when I saw ‘gluten-free’ on a package of bacon at the grocery store. Just because a food or beverage is gluten-free does not mean that the product is a healthful choice. Many cookies and chips are also now gluten-free, but provide only empty calories. Soda has always been gluten-free, but it’s obviously not a good choice either. So, while it may be hip and trendy, going gluten-free is neither necessary nor is it beneficial for the overwhelming majority of the U.S. population.

To learn more about nutrition, consider taking the Nutrition for Health and Fitness course. You need not be a health and fitness professional to attend, the general public is welcome!

 

Reference

Capannolo, A., Barkad, V.A., Ciccone, V.G., Melideo, D., Frieri, G.,  Latella, G. (2015).  Non-celiac gluten sensitivity among patients perceiving gluten-related symptoms.  Digestion. 30:92(1), 8-13.